Shingles

Shingles is a painful disease caused by the same herpes virus that causes chicken pox (herpes zoster). The first time a person is infected with herpes zoster, he or she gets chicken pox. After that, the virus becomes in active. At any time, it can become active again without warning. This time, the infection is shingles.

People who have HIV infection are 15 to 25 times more likely to get shingles than others. A person' CD4 cell count doesn' need to be low for shingles to occur. When CD4 cell counts drop below 50, however, there is a greater chance that the virus will infect other parts of the body, such as the eye. When the virus infects the retina at the back of the eye, blindness can result.

Symptoms

Herpes zoster lives in nerve tissue. The signs of an outbreak usually appear in two stages. The first stage may include:

• Itching
• Numbness
• Tingling or severe pain in a belt-like pattern on the chest, back or around the nose and eyes

About a week later the second stage begins with:

• A rash that begins as a bad or patch of raise dots on one side of the chest, face, belly, arms or legs. The rash looks like a band or belt. (The word shingles comes from a Latin word meaning belt or girdle. The word zoster is Greek for belt.) The rash follows the path of the inflamed nerve.
• The rash is painful. Usually the pain goes away as the rash goes away. In some cases, the pain can last for months or years.
• Small, fluid-filled blisters form. Within about two weeks, the blister break open and form crusty scabs. At this point, they no longer contain the virus. Scratching the blisters can lead to infections. These will need antibiotics and may leave scars. A typical case of shingles lasts about a month.

If the virus infects the nerves of the face or eye, shingles can appear on the mouth, face, neck, scalp, in or around the ears or on the tip of the nose. If a person gets herpes zoster on the forehead or near the eyes, he or she should see an ophthalmologist (a doctor who specializes in diseases of the eyes) right away. A herpes infection in the eye can be serious.

Causes

Varicella zoster virus, the same virus that causes chicken pox, causes shingles. This virus is in the herpes family. This is not the same virus that causes genital herpes infections or cold sores.

Shingles can only occur after someone has had chickenpox.

Risk Factors

The risk of getting shingles is higher in the following types of people with HIV infection:

• Gay or bisexual men
• Those younger than age 29
• People with a CD4 cell count of less than 500
• Whites rather than blacks or Hispanics

Shingles can occur in people with HIV shortly after they start taking strong antiviral medications. These cases of shingles are believed to be a sign of a recovering immune system.

Prevention

Currently, there is no way to predict an outbreak of shingles, and there is no medication approved to prevent it. Shingles is contagious. A person who has an outbreak should not get close to other people. Avoid contact with the shingles rash or with any materials that may have touched the shingles rash or blisters.

Diagnosis

Shingles is diagnosed on the basis of its appearance and the pattern of symptoms. A blood test can also identify the virus.

Treatment

Treatment for shingles focuses on fighting the virus and reducing pain.

Anti-herpes drugs work best when they are started within the first three days after the pain of shingles starts. They include acyclovir (Zovirax), which is usually given as pill taken five times a day. It can be given through a vein into the arm in more severe cases. Two new drugs Ð famciclovir (Famvir) and valacyclovir (Valtrex) are now available. They only need to be taken three times a day. All of these drugs must be taken for seven to 10 days.

To treat pain, several approaches can be used:

• Skin treatments. The anesthetic lidocaine has been available in a patch form since 1999. It provides pain relief for some people with shingles. Because it is used outside the body, it has less risk of side effects than pain pills.
• Pain medications. Some drugs normally used to treat depression, epilepsy, or severe pain are sometimes used for the pain of shingles. These can have a variety of side effects. Nortriptyline is the antidepressant most frequently used for shingles pain. Prednisone may be given to relieve the swelling (inflammation).
• Nerve blockers. These are injections of drugs that numb the pain or steroids. They are given as shots either into the nerves or into the spine to block the pain.